1821323940 NPI number — THE FOGARTY CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821323940 NPI number — THE FOGARTY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FOGARTY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PERSONAL CHOICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821323940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 MAPLE AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02806-3430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-245-7900
Provider Business Mailing Address Fax Number:
401-245-7910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MAPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02806-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-245-7900
Provider Business Practice Location Address Fax Number:
401-245-7910
Provider Enumeration Date:
10/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REISS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
401-245-7900

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  183 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OS59568 . This is a "DHS - STATE OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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